2. DAVID SUTTON PICTURES DR. Muhammad Bin Zulfiqar PGR-FCPS III
SIMS/SHL
3. Fig. 54.1 Normal and degenerative lumbar intervertebral
discs. Sagittal (A) and axial (B) MRI, T weighted contrast Normal
discs are surrounded by low signal from the annulus fibrosis and
partly divided horizontally by a low-signal band, not present in
children's discs.
4. Fig. 54.2 Normal and degenerative cervical intervertebral
discs and general anatomy. Sagittal MRI. (The cerebellar tonsus
seem to be low lying).
5. Fig. 54.3 Normal dorsal vertebral, CT axial section. Normal
defects in the cortex of the vertebral body for the passage of the
veins are shown; the posterior defect is for the basivertebral
veins. Note the circular spinal canal with equal sagittal and
coronal diameters.
6. Fig. 54.4 Myelogram and CT myelography in a patient with
rheumatoid arthritis and seemingly mild anterior atlanto-axial
subluxation and severe spinal cord damage. (A) Sagittal image
reformatted from multiple axial slices (no contrast). (B and C)
Lateral views of the myelogram in flexion and extension. (D) Axial
CT images of the myelogram showing the flattened damaged spinal
cord.
7. Fig. 54.4 Myelogram and CT myelography in a patient with
rheumatoid arthritis and seemingly mild anterior atlanto-axial
subluxation and severe spinal cord damage. (A) Sagittal image
reformatted from multiple axial slices (no contrast). (B and C)
Lateral views of the myelogram in flexion and extension. (D) Axial
CT images of the myelogram showing the flattened damaged spinal
cord.
8. Fig. 54.6 Extradural injection of contrast medium. Myodil
globules have extended throughout the lumbar and sacral epidural
space, through the intervertebral foramina and along the course of
the sacral plexuses.
9. Fig. 54.7 Subdural contrast medium. (A) AP projection. (B)
Lateral projection. (C) Oblique projection. The appearances
superficially simulating an enlarged spinal cord are due to the
contrast medium outlining the outer border of the arachnoid
membrane. Note that the inner border of the contrast column appears
lobulated and that its upper border does not form a fluid level
with unopacified CSF
10. Fig. 54.8 Spinal angiogram, selective injection. Normal
study. The arteria radicularis magna arises from the left tenth
intercostals artery. It fills the anterior spinal artery and there
is retrograde filling of other anterior radiculomedullary vessels.
The posterolateral arteries of the spinal cord are also filled
through the cruciate anastomosis at the conus.
11. Fig. 54.9 Dural arteriovenous fistula, left second lumbar
angiogram. AP and lateral projections. (A and B) Large arrow, the
fistula; small arrows, the draining vein.
12. Fig. 54.10 Cystic astrocytoma, cervical spine lateral
projection. The spinal canal is expanded. The posterior borders are
concave. The line of the conjoined laminae bordering the posterior
margin of the spinal canal is flattened and its length
increased.
13. Fig. 54.11 Neurofibromatosis. (A,B) Lumbar spine X-ray. The
L3/L4 intervertebral foramen is enlarged, with erosion of the
inferior border of the third lumbar pedicle and the adjacent part
of the posterior surface of the vertebral body. (C) Myelogram. A
neurofibroma on the fourth lumbar nerve root is partly intradural,
causing a well-defined filling defect within the theca at the L3
level, and partly extradural, displacing the theca medially away
from the pedicle and intervertebral foramen. There is another
intradural tumour at T11 /T12 level which deviates the termination
of the spinal cord and nerve roots toward the left and causes
complete obstruction. Histology showed this tumour to be a
neurofibrosarcoma.
14. Fig. 54.12 Lipomyelomeningodysplasia. Sagittal T,-weighted
image. There is high signal from the epidural fat and from the
lipomatous mass. The latter is subcutaneous, within the lumbosacral
spina bifida, and extends through the dura and then superiorly to
blend with the posterior border of the spinal cord which extends
down to the lumbosacral region. The dark band extending centrally
within the intradural part of the lipoma as far as the cord is
presumed to be a fibrous septum.
15. Fig. 54.13 Diastematomyelia. (A,B) Myelogram. The width of
the spinal canal is increased in the lower thoracic region and it
is divided by a bony spicule at T10 level. There is a long cleft of
the spinal cord extending from the fourth thoracic to the second
lumbar levels; the conus medullaris is at L3/4 disc level. (C)
Computed myelogram. Contiguous axial sections of lower thoracic
region pass through the bony spur which is dividing the spinal cord
and the subarachnoid space.
16. Fig. 54.13 Diastematomyelia. (A,B) Myelogram. The width of
the spinal canal is increased in the lower thoracic region and it
is divided by a bony spicule at T10 level. There is a long cleft of
the spinal cord extending from the fourth thoracic to the second
lumbar levels; the conus medullaris is at L3/4 disc level. (C)
Computed myelogram. Contiguous axial sections of lower thoracic
region pass through the bony spur which is dividing the spinal cord
and the subarachnoid space.
17. Fig. 54.14 Diastematomyelia, lipoma. (A) Sagittal T,-
weighted sequence. (B) Axial T1 sequence. A posteriorly situated
lipoma at L5 and S1 levels extends through the dura into the
subcutaneous tissues. A band extends from the inferior margin of
the posterior surface of the fifth lumbar vertebral body into the
lipoma. The spinal cord is divided into two unequal parts, which
extend one behind the other through the lumbar region and which
both blend into the anterior border of the lipoma at L5 level, with
the band passing between them.
18. Fig. 54.15 Chiari malformation, syringomyelia. Midsagittal
T1 weighted section through brainstem and upper cervical region.
The cerebellar tonsils are elongated and extend well below the
level of the arch of the atlas. The medulla is elongated and the
depressed dorsal column nuclei are below the tonsils. The medulla
is compressed between the odontoid and the depressed cerebellar
tonsils. There is a syrinx distending the spinal cord below the
inferior border of C2 and there is four-ventricular
hydrocephalus.
19. Fig. 54.16 Congenital fusion of cervical vertebrae with
spondylosis: myelogram. Congenital fusion of the fourth, fifth and
sixth cervical vertebrae with degenerative changes at discs above
and below. Osteophytes at C3/4 level compress the spinal cord and
nerve root sheaths. Osteophytes at C6/7 level compress the root
sheaths only.
20. Fig 54.17 Atlanto-occipital assimilation: reformatted CT
sections in coronal (A), sagittal (B,C) through condyles and axial
(D) planes. The left occipital condyle and lateral mass of atlas
are small, relatively dense and completely fused. The joint space
between the right occipital condyle and lateral mass is incomplete.
The posterior arch of the atlas is closely applied but not fused to
the skull bone.
21. Fig. 54.18 Absent thoracic pedicle: CT. The left pedicle of
the seventh thoracic vertebra is almost completely absent. The bone
bordering the defect is corticated and the articulation with the
corresponding rib is anomalous. The bone defect is filled by fat
continuous with the epidural fat outlining the outer margin of the
dura, which is in a normal position.
22. Fig. 54.19 (A,B) Dural ectasia in neurofibromatosis:
myelogram. The subarachnoid space is markedly expanded in the lower
half of the thoracic and upper lumbar regions. The corresponding
part of the spinal canal is markedly expanded in this region and
there is erosion of the posterior borders of the vertebral bodies
and of the pedicles.
23. Fig. 54.20 Comminuted fracture of thoracic spine: fractures
of the ninth and eighth thoracic vertebrae with anterior
subluxation of the eighth. Axial sections through the ninth (A) and
the eighth (B) thoracic vertebra, and reformatted sagittal (C) and
coronal (D) sections. There is a comminuted fracture with
disruption of the body and neural arch of the ninth thoracic
vertebra. A fragment has been separated from the posterior inferior
margin of the body of the eighth thoracic vertebra and there is
anterior subluxation of the rest of the vertebra. The spinal canal
is markedly narrowed and the spinal cord is compressed by displaced
bone fragments. The subarachnoid space is opacified by a blood clot
at T9 and T10 levels. (E,F) MRI of cervical spine. Whiplash injury
in road traffic accident 6 months previously. Sagittal sections:
T,-weighted (E); T2 weighted (F). The spinal canal is narrowed due
to spondylosis. A small focus of aging haematoma is shown in the
spinal cord at CT, possibly an unrelated cavernoma rather than an
evolving haemorrhagic contusion.
24. Fig. 54.20 Comminuted fracture of thoracic spine: fractures
of the ninth and eighth thoracic vertebrae with anterior
subluxation of the eighth. Axial sections through the ninth (A) and
the eighth (B) thoracic vertebra, and reformatted sagittal (C) and
coronal (D) sections. There is a comminuted fracture with
disruption of the body and neural arch of the ninth thoracic
vertebra. A fragment has been separated from the posterior inferior
margin of the body of the eighth thoracic vertebra and there is
anterior subluxation of the rest of the vertebra. The spinal canal
is markedly narrowed and the spinal cord is compressed by displaced
bone fragments. The subarachnoid space is opacified by a blood clot
at T9 and T10 levels. (E,F) MRI of cervical spine. Whiplash injury
in road traffic accident 6 months previously. Sagittal sections:
T,- weighted (E); T2 weighted (F). The spinal canal is narrowed due
to spondylosis. A small focus of aging haematoma is shown in the
spinal cord at CT, possibly an unrelated cavernoma rather than an
evolving haemorrhagic contusion.
25. Fig. 54.21 Old fracture of odontoid peg with non-union and
anterior subluxation. (A) Reformatted sagittal section. (B-E) Axial
sections. B is at the level of the upper border of the anterior
arch of the atlas, C at the level of the lower border of displaced
odontoid, D through the upper border of the posterior arch of the
second cervical vertebra, and E 3mm below D. The theca is impressed
by the posterior margin of the lower fragment of the second
cervical vertebra, and the spinal cord is deformed and compressed
between it and the posterior arch of the first cervical vertebra.
Arrows mark anterior arch of atlas, odontoid fragment, lower
fragment of second cervical vertebra; arrowhead = posterior arch of
second cervical vertebra.
26. Fig. 54.22 Rheumatoid arthritis. Sagittal MRI, T2 -
weighted contrast. Severe erosion of the odontoid, vertical
atlanto-axial subluxation and degenerate subaxial disease with
spinal cord damage are shown.
27. Fig. 54.23. Rheumatoid arthritis with atlanto-axial
subluxation. (A,B) CT axial sections at level of the atlas. (C)
Midsagittal reformatted section. There is erosion of the odontoid
peg and anterior subluxation of the atlas; the spinal cord is
compressed by the odontoid peg and posterior arch of the
atlas.
28. Fig. 54.24 Spondylolisthesis of the fourth lumbar vertebra
at CT. (A,a) At the level of the pedicles and superior articular
facets. (B,b) Through fractured pars intra-articularis. Images are
made at window setting appropriate to show both soft tissue and
bone. Note that the forward slip of the body of L4 has elongated
the sagittal diameter of the spinal canal; there is no nerve root
compression.
29. Fig. 54.25 Degenerative lumbar canal stenosis: T 2
-weighted sagittal section of lumbar spine. There is low signal
from all the discs, indicating ageing, but the decline in intensity
is greater in the lower lumbar region due to additional disc
degeneration with dehydration. The lower lumbar discs are narrowed
and there is anterior subluxation of two vertebral bodies, with
minor posterior protrusion of the annuli impressing the anterior
surface of the theca. There is more prominent impression of the
posterior surface of the theca due to infolding of the posterior
ligaments associated with apophyseal osteoarthritis. The
combination is causing degenerative canal stenosis.
30. Fig. 54.26 Acute intraspinal haemorrhage. Sagittal (A) and
axial (B) MRI with T,-weighted contrast. The extensive posteriorly
located haematoma is well shown. This one probabally is subdural in
location, and was spontaneous.
31. Fig. 54.27 Pyogenic infection, L5/S1 disc. (A) Axial
section at level of L5; (B) at level of S1. (C) Axial reformatted
section. The bone is destroyed adjacent to the disc space, leaving
a large cavity with adjacent sclerosis around the disc. There is no
intraspinal extension.
32. Fig. 54.28 Neurofibroma: axial section, cervical region, T
1- weighte sequence. There is a slightly lobulated mass grossly
enlarging the left inter-vertebral foramen and eroding the adjacent
bone. An intraspinal component of the mass displaces the theca and
spinal cord toward the right and compresses them. A paravertebral
component forms a mass displacing the deep cervical muscles. The
extent of this dumb- bell neurofibroma is evident from this single
study.
33. Fig. 54.29 Metastasis CT. Sclerotic metastases involving
the right side of the sacrum were shown by plain films but are seen
more clearly by axial CT. This also shows bone destruction around
the right sacral foramen and a vertical pathological fracture
through the body of the sacrum.
34. Fig. 54.30 (A) Osteoblastoma of cervical spine. The right
pedicle and lateral mass of the sixth cervical vertebra are
enlarged and sclerotic, with an irregular central low-density
nidus. (B) Osteoid osteoma. CT scan of mid-thoracic spine. There is
sclerosis with focal expansion involving the left lamina. The
tumour encroaches on the epidural space and contains a small nidus
which is of low density.
35. Fig. 54.31 Sacral chordoma. (A) A fairly well defined
region of destruction involving the bodies and left lateral masses
of the lowest two segments of the sacrum. (B,C) CT sections through
the fourth and fifth segments of the sacrum. A mass of density
slightly lower than that of muscle is expanding and destroying the
bone of the bodies and left lateral masses of the fourth and fifth
segments of the sacrum. (Contrast in loops of small bowel)
36. Fig. 54.32 Haemangioma of bone, lateral lumbar spine. The
secondary trabeculae of the body of the second lumbar vertebra are
thickened; the vertical striate appearance is typical of a
haemangioma.
37. Fig. 54.33 Paget's disease. (A) Lateral thoracic spine. The
body and neural arch of the twelfth thoracic vertebra are enlarged
and the bone texture is abnormal. (B,C) CT axial sections, lower
dorsal vertebra. Note abnormal irregular bone texture throughout
the vertebral body, neural arch and appendages; the whole vertebra
is slightly enlarged.
38. Fig. 54.34 Far lateral lumbar disc prolapse. (A,B) CT axial
sections. (A) Through L3/4 disc space, showing a soft-tissue mass
contiguous with the right posterolateral aspect of the disc,
encroaching into the intervertebral foramen and extending lateral
to it. (B) Section 6mm higher than A, and at level of the lower
part of the body of the third lumbar vertebra. The disc prolapse
forms a soft-tissue mass in the path of the emerging right L3 nerve
root, which is not visible due to the absence of epidural fat. The
left L3 root (arrow) is clearly shown. (C,D) MRI L4/5 lateral disc
prolapse. Sagittal T1 -weighted sections. Encroachment of prolapsed
disc substance into the L4/5 intervertebral foramen obliterates the
epidural fat around the emerging nerve root.
39. Fig. 54.34 Far lateral lumbar disc prolapse. (A,B) CT axial
sections. (A) Through L3/4 disc space, showing a soft-tissue mass
contiguous with the right posterolateral aspect of the disc,
encroaching into the intervertebral foramen and extending lateral
to it. (B) Section 6mm higher than A, and at level of the lower
part of the body of the third lumbar vertebra. The disc prolapse
forms a soft-tissue mass in the path of the emerging right L3 nerve
root, which is not visible due to the absence of epidural fat. The
left L3 root (arrow) is clearly shown. (C,D) MRI L4/5 lateral disc
prolapse. Sagittal T1 - weighted sections. Encroachment of
prolapsed disc substance into the L4/5 intervertebral foramen
obliterates the epidural fat around the emerging nerve root.
40. Fig. 54.35 Extruded (sequestrated) disc protrusion. (A)
Sagittal T 2- weighted section of lumbar spine. The L4/5 disc space
is narrowed and the signal returned from the nucleus is decreased.
There is a slightly lobulated extradural mass behind the L4/5 disc
and upper half of the body of the fifth lumbar vertebra which is
compressing the spinal theca. The signal returned from it is
similar to that of the normal L3/4 nucleus. It was an extruded
fragment removed at surgery. Such fragments commonly give higher
signal than the damaged disc from which they originate. (B-E)
Sequestrated lumbosacral disc prolapse. T,-weighted sections lumbar
spine: B,C sagittal; D,E axial. The disc fragment extends behind
the upper part of the right side of the body of the sacrum. It
displaces the first sacral nerve root posteriorly and erodes the
sacral body.
41. Fig. 54.35 Extruded (sequestrated) disc protrusion. (A)
Sagittal T 2- weighted section of lumbar spine. The L4/5 disc space
is narrowed and the signal returned from the nucleus is decreased.
There is a slightly lobulated extradural mass behind the L4/5 disc
and upper half of the body of the fifth lumbar vertebra which is
compressing the spinal theca. The signal returned from it is
similar to that of the normal L3/4 nucleus. It was an extruded
fragment removed at surgery. Such fragments commonly give higher
signal than the damaged disc from which they originate. (B-E)
Sequestrated lumbosacral disc prolapse. T,-weighted sections lumbar
spine: B,C sagittal; D,E axial. The disc fragment extends behind
the upper part of the right side of the body of the sacrum. It
displaces the first sacral nerve root posteriorly and erodes the
sacral body.
42. Fig. 54.36 Extruded fragment from a degenerate L3/L4
intervertebral disc. (A,B) Sagittal and axial MRI with T2-weighted
contrast. A large migratory extruded disc fragment ascends on the
right behind the L3 vertebral body. (C,D) Sagittal and axial MRI 8
weeks later shows spontaneous resolution of the extrusion.
43. Fig. 54.37 Ossification of the posterior longitudinal
ligament. Sagittal (A) and axial (B) MRI with T 2 - weighted
contrast. The axial image is between the intervertebral discs and
shows the large low-signal thickened ligament looking somewhat like
a mushroom.
44. Fig. 54.38 Lumbar spinal canal stenosis with entrapment of
the cauda equina. Sagittal MRI with T 2 - weighted contrast showing
stenosis of the spinal canal at L4-L5; CSF signal is excluded at
the level of the stenosis, and there is redundant coiling of many
of the intradural spinal roots above
45. Fig. 54.39 Canal stenosis. CT sections through lumbar
spinal canal. Note the short pedicles (bottom right image) and
medially placed apophyseal joints. The combination causes marked
reduction of the sagittal diameter of the lateral parts of the
spinal canal, which is further compromised by osteoarthritic
changes in the apophyseal joints.
46. Fig. 54.40 Syringomyelia. Parasagittal T,-weighted
sequence. The low signal subarachnoid CSF outlines the expanded
spinal cord and also the intramedullary cyst, which shows a typical
lobulated appearance. One of the cerebellar tonsils is outlined
with its lower pole extending to the level of the arch of the
atlas.
47. Fig. 54.41 Ependymoma. Sagittal and axial with T2-weighted
contrast shows an extensive tumour filling much of the lumbosacral
spinal canal and cavitated spinal cord above.
48. Fig. 54.42 Intradural lipoma. T1 - weighted MRI. Sagittal
section through posterior fossa and upper cervical region. The
posterior fossa and foramen magnum are normal. There is a large
mass returning high signal and typical of fat. It lies within the
subarachnoid space posteriorly, enlarging the spinal canal and
displacing the spinal cord anteriorly. The spinal cord is markedly
thinned and the cord substance appears to be almost completely
replaced by fat over most of the extent of the tumour. The
appearances are typical of a large intradural and partially
intramedullary lipoma. These tumours typically extrude from the
posterior surface of the cord between the dorsal columns.
49. Fig. 54.43 Multiple sclerosis. An axial T 2 - weighted MRI
at C6 shows a typical plaque in the right lateral column, reaching
to the pial surface of the spinal cord.
50. Fig. 54.44 Myelogram neurofibroma. (A) AP projection. (B)
Oblique projection. The tumour is intradural on the right side at
C4/5 level and its margins are clearly outlined by the contrast
medium in the subarachnoid space which is widened around the
tumour. The spinal cord is compressed and displaced by the
mass.
51. Fig. 54.45 Neurofibromatosis with multiple tumours.
Sagittal T,-weighted MRI sections. (A) Posterior fossa and cervical
region. (B) Thoracic region. (C) Cervical region after gadolinium
enhancement. (D) Thoracic region after gadolinium enhancement. The
patient has neurofibromatosis and there are multiple tumours. Some
are intradural extramedullary schwannomas. A good example is shown
anteriorly at C2 level. The upper border of this tumour is outlined
against the cerebrospinal fluid, but its posterior border blends
with the spinal cord which gives signal of similar intensity. The
extent of this tumour i s evident on the enhanced scan. Some of the
tumours are extradural. An example is shown posteriorly in the
mid-thoracic region B; the upper and lower borders are outlined
against the extradural fat behind the spinal cord. The anterior
margin is only slightly denser than the cord substance. After
injecting gadolinium (D), the tumour is enhanced. Its anterior
border, which is compressing the dura and the cord, is more evident
but the intensity of signal from the enhanced tumour is similar to
that of the epidural fat, making the upper and lower limits more
difficult to define. An intramedullary tumour is also present,
expanding the cord in the lower dorsal region. The margins are not
distinguished from cord substance on the plain scan B but are
evident with ring enhancement after gadolinium (arrow in D).
52. Fig. 54.45 Neurofibromatosis with multiple tumours.
Sagittal T,- weighted MRI sections. (A) Posterior fossa and
cervical region. (B) Thoracic region. (C) Cervical region after
gadolinium enhancement. (D) Thoracic region after gadolinium
enhancement. The patient has neurofibromatosis and there are
multiple tumours. Some are intradural extramedullary schwannomas. A
good example is shown anteriorly at C2 level. The upper border of
this tumour is outlined against the cerebrospinal fluid, but its
posterior border blends with the spinal cord which gives signal of
similar intensity. The extent of this tumour i s evident on the
enhanced scan. Some of the tumours are extradural. An example is
shown posteriorly in the mid-thoracic region B; the upper and lower
borders are outlined against the extradural fat behind the spinal
cord. The anterior margin is only slightly denser than the cord
substance. After injecting gadolinium (D), the tumour is enhanced.
Its anterior border, which is compressing the dura and the cord, is
more evident but the intensity of signal from the enhanced tumour
is similar to that of the epidural fat, making the upper and lower
limits more difficult to define. An intramedullary tumour is also
present, expanding the cord in the lower dorsal region. The margins
are not distinguished from cord substance on the plain scan B but
are evident with ring enhancement after gadolinium (arrow in
D).
53. Fig. 54.46 Meningioma. (A,B) Myelogram. A partially
calcified mass forms a slightly irregular defect within the theca
on the left side posteriorly in the upper thoracic region and
compresses the spinal cord. (C,D) Computed myelogram. The
calcification within the tumour is mainly peripheral and is well
shown on D, where the subarachnoid space is almost totally
occluded. On C, the irregular medial margin of the tumour is shown,
together with the flattened spinal cord, which is displaced
anteriorly and towards the right. (E-G) Cervical meningioma-MRI: T2
weighted E; T,- weighted F; T,-weighted after gadolinium G. The
tumour has a broad base on the dura anterior to the spinal cord
which is displaced posteriorly and compressed. The tumour returns
high signal on T 2 -low on T,-weighted, and enhances markedly.
54. Fig. 54.46 Meningioma. (A,B) Myelogram. A partially
calcified mass forms a slightly irregular defect within the theca
on the left side posteriorly in the upper thoracic region and
compresses the spinal cord. (C,D) Computed myelogram. The
calcification within the tumour is mainly peripheral and is well
shown on D, where the subarachnoid space is almost totally
occluded. On C, the irregular medial margin of the tumour is shown,
together with the flattened spinal cord, which is displaced
anteriorly and towards the right. (E- G) Cervical meningioma-MRI:
T2 weighted E; T,-weighted F; T,- weighted after gadolinium G. The
tumour has a broad base on the dura anterior to the spinal cord
which is displaced posteriorly and compressed. The tumour returns
high signal on T 2 -low on T,- weighted, and enhances
markedly.
55. Fig. 54.46 Meningioma. (A,B) Myelogram. A partially
calcified mass forms a slightly irregular defect within the theca
on the left side posteriorly in the upper thoracic region and
compresses the spinal cord. (C,D) Computed myelogram. The
calcification within the tumour is mainly peripheral and is well
shown on D, where the subarachnoid space is almost totally
occluded. On C, the irregular medial margin of the tumour is shown,
together with the flattened spinal cord, which is displaced
anteriorly and towards the right. (E-G) Cervical meningioma-MRI: T2
weighted E; T,-weighted F; T,-weighted after gadolinium G. The
tumour has a broad base on the dura anterior to the spinal cord
which is displaced posteriorly and compressed. The tumour returns
high signal on T 2 -low on T,-weighted, and enhances markedly.
56. Fig. 54.47 Spinal dural arteriovenous fistula with
intradural drainage. Sagittal (A) and coronal (B) MRI with T2 -
weighted contrast in the cervical region showing markedly enlarged
intradural veins.
57. Fig. 54.48 Dural arteriovenous fistula, left second lumbar
angiogram. (A) AP projection. (B) Lateral projection. The fistula
is on the left side of the dura at L2 level and it drains
superiorly through a vein ascending along the posterolateral aspect
of the subarachnoid space to enter the posterior coronal venous
system at T12 level. Veins then pass around the left side of the
cord to fill the anterior coronal plexus also. Large arrow =
fistula; small arrows = draining vein.
58. Fig. 54.49 AVM of the spinal cord. (A) Left vertebral
angiogram. (B) Left sixth intercostal angiogram. The AVM is at the
cervico-thoracic junction. It is supplied (A) from above by the
enlarged anterior spinal artery descending from the cervical region
and (B) by an enlarged tortuous vessel, presumably a posterior
spinal artery, ascending along the posterolateral aspect of the
cord.